TWO YEAR NEUROLOGICAL OUTCOMES OF VERY LOW BIRTH WEIGHT INFANTS

Background: High risk newborns such as the Very Low Birth Weight (VLBW) require long term follow up to ascertain their subsequent survival and quality of life (based on neurological intactness). Though such data is now standard in the developed world, little is known in published literature about the situation in resource constrained countries.Objective: To describe the neurological outcomes of VLBW infants evaluated at two years of age.Design: Longitudinal descriptive survey.Setting: Kenyatta National Hospital’s Newborn Unit during the year 2002.Subjects: One hundred and twenty infants born weighing 1000 grams and 1500 grams followed up until the age of 24 months.Results: Of the 120 infants evaluated, 14 (11.7%; 95% Cl 6.2-17.1) had cerebral palsy, 11 (9.2%; 95% Cl 4.8-16.9) were delayed on cognitive assessment while 32 (26.7%; 95% Cl 9.3-38.1) were found tohave functional disabilities. The factors associated with functional disability in the cohort included; neonatal illness (P = 0.005, 95% Cl 1.26<2.43<4.69), exclusive use of breast milk in the first month (P = 0.02, 95% Cl 1.10<2.04<3.78), neonatal weight gain less than 15 grams/kg/day (P = 0.014, 95% Cl1.13<2.24<4.42), history of re-hospitalisation (P<0.001, 95% Cl 1.72<3.33<6.34) and weight less than the third percentile at two years (P = 0.019, 95%1.09<2.22<4.53).Conclusions: Neurological dysfunction was more frequent in this cohort than presently reported from other centres. The cross-tabulations indicate that history of neonatal illness, choice of early nutrition, slower growth and post discharge morbidity were associated with subsequent neurological dysfunction. The factors associated with developmental delay in this cohort should be explored further in order to determine the manipulations required in the newborn period forimprovement of neurological outcomes among these high risk infants

NEONATAL SURVIVAL OF INFANTS LESS THAN 2000 GRAMS BORN AT KENYATTA NATIONAL HOSPITAL

Background: Survival of patients is regularly used as a measure of the level and appropriatenessof medical care provided by institutions. Newborn services have been evaluated in thismanner since the 1960s. Though Kenyatta National Hospital has provided neonatal servicesfor over 25 years, no survival data for the low birth weight infants has been published since1978.Objective: To determine the birthweight specific neonatal survival of infants born weighingless than 2000 grams at Kenyatta National Hospital.Design: A cross sectional survey.Setting: Newborn Unit, Kenyatta National Hospital, Nairobi.Main outcome measures: The proportion of infants surviving the first 28 days of life groupedin the following birthweight categories; below 1000 grams (extremely low birthweight), 1000- 1499 grams (very low birthweight) and 1500 - 1999 grams (low birthweight).Results: The overall neonatal survival of 163 infants born below 2000 grams was 62.6%. Noneof the 23 infants born less than 1000 grams survived the neonatal period. Bigger infants faredmuch better with 68% (n=73) of the 1000 - 1499 and 78% (n=67) of the 1500-1999 gram groupssurviving. Survival based on gestational age was also determined. Sixty nine per cent of infantsborn between 32 and 35 weeks survived while only 27% and 9% of the 28 - 31 weeks and thoseless than 28 weeks survived respectively. When the patients were analysed for age at death, itwas found that over 28% of the deaths occurred within the first day and by the seventh day,more than 70% had died. Less than 30% of the deaths occurred after the first week. Thecommonest clinical syndromes seen were infection (41%) and respiratory distress (43%).Conclusion: Neonatal survival rates of low birthweight infants are still much lower thanthose observed in developed countries as far back as the early 1970’s. The big proportion ofdeaths occurring during the first week, and in particular the first day, is due to lack ofneonatal intensive care facilities and inadequate obstetric services

CHLAMYDIA AS A CAUSE OF LATE NEONATAL PNEUMONIA AT KENYATTA NATIONAL HOSPITAL, NAIROBI

Background: Neonatal pneumonia is a common cause of morbidity and mortality allover the world. The problem is known to be higher in resource poor third worldcountries. Organisms (such as chlamydia) not covered by routine laboratory tests andregular antibiotic regimes may frequently contribute towards the causation of lateneonatal pneumonia. It is therefore useful to gather epidemiological evidence to guidein the routine diagnosis and treatment of such infections.Objective: To determine the prevalence of chlamydia associated pneumonia amonginfants developing the disease between the 7th and 30th days of life (late neonatalpneumonia).Design: Cross sectional survey.Setting: Newborn Unit, Kenyatta National Hospital.Subjects: Fifty two newborns clinically diagnosed as having late neonatal pneumonia.They were all subjected to chest X-rays to confirm the clinical diagnosis. Nasopharyngealaspirates for chlamydia antigen detection tests were then performed on all patients. Thestudy was undertaken during the months of September through to November 2000.Main outcome measures: The proportion of newborns with late neonatal pneumonia thathave chlamydia trachomantis as the sole or contributory causative agent.Results: Fifty two newborns of postnatal age between seven and 30 days were recruited.Their sex distribution was about 1:1. Thirty three (63.5%) of these infants were foundwith chlamydia in their upper airways. Thirty out of 47 available chest X-rays, representing63.8% had evidence of interstitial pneumonitis. Chlamydia associated pneumonia indicatedby the presence of both interstitial pneumonia and colonization of the upper air wayswas present in 24 out of 47 patients, 51% of the total cases of late neonatal pneumonia.When X-rays alone were compared with our gold standard for the diagnosis of chlamydiapneumonia (radiology and colonization), we computed a sensitivity of 100%, specificity73%, negative predictive value 100% and positive predictive value of 80%. Mode ofdelivery, birth weight and gestation had no association with nasopharyngeal colonizationby chlamydia or actual diagnosis of chlamydia pneumonia.Conclusion: The prevalence of chlamydia associated infection among newborns with lateneonatal pneumonia at Kenyatta National Hospital is 51%, eight times more than thatreported elsewhere. Chest X-rays appear to be a reliable diagnostic tool in this group.The use of antichlamydial drugs in addition to the regular antibiotics whenever adiagnosis of late neonatal pneumonia is made is justifiable